Impact of SARS-CoV2 vaccine on migraine course in patients receiving CGRP monoclonal antibodies

Abstract text (incl. figure legends and references)

Questions COVID-19 vaccines reduce the risk of death and major sequelae related to SARS-CoV2. Despite proven safety, they present adverse events among which headache is one of the most frequently reported. We aim to evaluate vaccine impact on headache frequency in migraine patients receiving monoclonal antibodies targeting CGRP pathway (anti-CGRP mAbs)

Methods We enrolled 139 migraine patients actively treated with one of the 3 anti-CGRPmAbs currently available in Italy(erenumab, galcanezumab or fremanezumab). We collected: i) clinical and demographic data; ii) self-perceived headache changes after the 1^st and 2^nd vaccine doses (frequency, intensity and acute drug's efficacy); iii) monthly headache and migraine days (MHD and MMD), days and doses of acute drug intake in the month before(m_pre) and after(m_post) vaccine administrations through paper diaries

Results The dataset is formed by 100 migraine patients who received COVID-19 vaccine(fig.1) during mAbs treatment (73% females, migraine history 36.7±12.2yrs). At baseline 96% of patients had a diagnosis of chronic migraine (86.5% of them also had medication overuse headache). 13% of the patients reported a subjective worsening of headache frequency and intensity. Still, headache diaries demonstrated an objective reduction in MHD, days and doses of acute drug intake after the 1^st and 2^nd vaccine doses. All parameters showed a reduction trend without reaching significance, except for MHD after the 1^stvaccine dose (MHD1^stdose m_pre 14.6±9.8;m_post13.2±9.7, p=0.01; 2^nddose m_pre14.0±10.9; m_post13.0±9.7,p=0.15)(fig.2). No correlation was found between demographic or baseline headache features and subjective headache worsening

Conclusions In our cohort of migraine patients treated with anti-CGRPmAbs, COVID-19 vaccination did not induced any worsening in migraine characteristics. Our data suggest that mAbs treatment may prevent headache worsening frequently reported in patients with migraine exposed to COVID-19 vaccination